No abstract
resumo Neste artigo analisamos as condições de vulnerabilidades social e em saúde e a segregação residencial no município de São Paulo e o potencial uso de medidas científicas para instrumentos de financiamento urbano enquanto política pública promotora de inclusão socioterritorial. A pesquisa investiga quatro problemas complementares, com enfoques inter e multi-disciplinares, ao analisar: (i) as evidências que vinculam as condições de saúde e vulnerabilidade socioespacial no território; (ii) os principais indicadores das condições de segregação residencial e desigualdades socioespaciais; (iii) os principais instrumentos de financiamento urbano existentes na política fundiária com maior potencial de utilização no financiamento da mitigação das desigualdades sociais e em saúde no uso do território. Ao apontar a carência da utilização de evidências empíricas, indicadores baseados em pesquisa científica, na aplicação dos instrumentos de financiamento urbano identificados como promotores da mitigação das desigualdades, o artigo discute o aperfeiçoamento do instrumento, com base em indicadores espacializados de vulnerabilidade social e em saúde urbana, colocando-o como potente ferramenta de política pública multisetorial integrada e territorializada.
This study reported the frequency of anesthetic overdose measured with the bispectral index in a high altitude city (Bogotá-Colombia, 2600 meters above sea level). We assembled a prospective cohort of patients. Preoperative variables were described, and 10 minutes after the surgical incision, bispectral index, mean alveolar concentration, mean arterial pressure, and oxygen saturation were recorded. Bispectral index was classified as superficial (60), adequate (40–60), and deep (> 40). Mean alveolar concentration was classified as low (< 0.8), normal (0.8–1.2), and high (> 1.2). We included 50 patients. The mean age of the patients was 36.3 ± 13.5 years; 48% were male and 78% were categorized as ASA I. Mean values of mean alveolar concentration and bispectral index were 1.14 ± 0.18 and 38.66 ± 6.9, respectively. Frequency of anesthetic overdose measured with bispectral index was 54% and only 20% with mean alveolar concentration. In total, 78% of patients received normal mean alveolar concentration values, and among these patients, 49% had deep bispectral index levels and 51% were adequate. There was no correlation between mean alveolar concentration and bispectral index (Pearson r = 0.161, P = 0.246) or between bispectral index and mean arterial pressure (Pearson r = 0.367, P = 0.08). All patients older than 60 years exhibited deep bispectral index levels, and although we did not identify a correlation between age and bispectral index, a tendency was observed (Pearson r = –0.087, P = 0.538). Safe and effective anesthesia overdose could be a common phenomenon. Bispectral index-guided anesthesia could be a helpful and reliable tool in the assessment and prevention of anesthesia overdose at high altitude. The study was approved by the ethics committee of the Fundación Cardioinfantil-Instituto de cardiología, Bogota, Colombia (approved number: 312017).
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